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Vaccines: When Concern isn’t Anti-Vaccine, Why Hep B is on the Schedule, and Why I Vaccinate my Children

September 4, 2010

In the previous post, I wrote about anti-vaccine rhetoric being riskier than vaccine injuries. A friend commented that we shouldn’t lump all people who are concerned about vaccines as anti-vaxxers. I don’t. I never have. Here’s the response (and some additional thoughts) I wrote, although I’d also recommend looking directly at the comments in the previous piece, since the comments there may end up being rather interesting.

I don’t lump people with concerns about vaccines into the anti-vax category; I didn’t do that in this piece, nor am I aware that I have done that in any piece I have written. 

Everyone should be concerned about vaccines, medications, and the treatments they use. They should be informed consumers and make the best decisions they can about their health care choices.

Not everyone can be safely vaccinated. They are clearly not anti-vaccine. In addition, there are others who need to space out vaccines. They are clearly not anti-vaccine. 

The nine folks or so who had commented over at Huff were clearly against vaccination PERIOD. Many of the posters at AoA are clearly, admittedly and proudly anti-vaccine at the same time that they are clearly, admittedly, and proudly in favor of giving their children chelators, hbot, IVIG, nicotine patches, oxytocin, and other unproven (in regards to autism) treatments. In other words, they refuse to vaccinate their children on unfounded fears about relative risks while at the same time placing their children at far greater risks from the treatments in order to cure their children of autism. I’m not talking about children with accompanying medical illnesses who get needed and doctor-guided medical treatment (while noting that many such doctors may be giving these parents incredibly BAD medical advice and harming these children).

There are no easy answers; there are an overabundance of questions, and when we fail to both think and act rationally and show compassion to those facing tremendous challenges all while being called on to make incredibly difficult decisions, we short ourselves and our community. 

Less compassion, though, is merited to those who stridently, proudly, and deliberately intend to destroy the vaccine program because they believe it to be the root of all evils. 

Many people are concerned about Hep B. Age of Autism, Wakefield, and Kirby turned towards the Hep B vaccine last year as their other vaccine culprits were resoundingly debunked. 

Hep B vaccine is a favorite of die-hard anti-vaccine people. They tout the disease as a sexually transmitted disease and write screeds that there are no needles, drug users, or prostitutes in their homes so babies don’t need the vaccine.  The truth is that Hep B worldwide is a huge problem and it isn’t just about needles or prostitutes. Death because of Hep B is almost entirely preventable with vaccine use. 

According to WHO:

“Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.

The virus is transmitted through contact with the blood or other body fluids of an infected person – not through casual contact.

About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.

About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.

The hepatitis B virus is 50 to 100 times more infectious than HIV.

Hepatitis B virus is an important occupational hazard for health workers.

Hepatitis B is preventable with a safe and effective vaccine.”

And here, in a concise nutshell, is why babies are inoculated against Hep B: “The virus incubation period is 90 days on average, but can vary from about 30 to 180 days. HBV may be detected 30 to 60 days after infection and persist for widely variable periods of time.”

The factsheet continues:

“All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.

The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).

The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.

All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:  

persons with high-risk sexual behaviour;

partners and household contacts of HBV infected persons; 

injecting drug users; 

persons who frequently require blood or blood products;

recipients of solid organ transplantation;

those at occupational risk of HBV infection, including health care workers; and

international travellers to countries with high rates of HBV.

The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.

As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes – a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.”

There are good reasons for having children vaccinated against Hep B. Are the risks here in the US as great as they are elsewhere? No, they’re not, but it doesn’t mean there is no risk. According to NNii, these are the main reasons why infants and children should receive the Hep B vaccine (I don’t know what’s with the apparent code in the quotation; I’ve kept it there since I’m quoting verbatim):
Why Parents Should Vaccinate Their Children against HBV 
While HBV is most effectively transmitted from one person to another through blood and body fluids by sexual contact, injection drug use, or occupational exposure,

  •  As many as 16%-30% of hepatitis B cases have no known source of infection.[fn]CDC.Sentinel Counties Study of Viral Hepatitis (1992-1993, unpublished data)[/fn] [fn]CDC, National Immunization Program (NIP). (2004). Hepatitis B. In Epidemiology and prevention of vaccine-preventable diseases (“The Pink Book”) (8th ed.). Atlanta: Author.[/fn]
  • Mothers who have chronic HBV infection can transmit the virus to their newborns. They are often unaware that they are HBV infected. There are specific recommendations for the management of infants born to either HBV infected mothers or to mothers with unknown HBV infection status.[fn value=”1”][/fn]
  • For children, the most common sources of HBV infection is from their mother at birth or subsequently, or by transmission from an infected household contact.[fn value=”2”][/fn] 
  • Unvaccinated children in families with no known risk factors are still at risk of infection through normal play activities. The sources of their infection are unknown but HBV could be transmitted through contact of non-intact skin (as occurs in school yard abrasions), by sharing contaminated inanimate objects (such as toothbrushes, towels, or bed sheets), and by being bitten.[fn]Shapiro CN, McCaig LF, Gensheimer KF, et al (1989). Hepatitis B virus transmission between children in day care. Pediatric Infectious Diseases Journal 8:870-875.[/fn] [fn]Oleske J, Minnefor A, Cooper R Jr, et al (1980). Transmission of hepatitis B in a classroom setting. Journal of Pediatrics 97:770-772.[/fn] [fn]Daseda CC, Shapiro CN, Carroll K, et al. (1994). Hepatitis B virus transmission between a child and staff member at a day-care center. Pediatr Infect Dis J13; 828-30.[/fn] Thus, children whose families seemingly are not at risk of HBV infection may also be at risk of becoming HBV-infected, as there is no way to know which child will eventually be exposed. 
  • Teenagers have increased risk of HBV exposure when they become sexually active.
For these reasons, HBV vaccine is recommended for everyone 18 years and younger, starting with the first dose shortly after birth (prior to discharge from the newborn nursery).[fn value=”1”][/fn] Of course, anyone with risk factors should also be immunized no matter what their age.[fn value=”1”][/fn]”

When we get our information from sources who insist that vaccines are injected into the bloodstream, that studies of a dozen monkeys or a case series of a dozen children are persuasive science but studies with a half a million children or more are not, we’re going to make decisions based on misinformation and fear instead of on reliable information. Sites that provide a voice to such heated, dismally wrong rhetoric promulgate misinformation. We have to, in order to reject the information we are exposed to, actively consider it and question it; otherwise we accept it wholesale, without the realization that we have done so. Reading such sites convey real risks that we may, without any overt awareness, accept bad information as good information and proceed to make poorly informed decisions. 

We should make our health care decisions based on factual information and reason. We should, I believe, where we can safely vaccinate ourselves and our children, do so, both to protect ourselves and our community. I do believe in the greater good and personal responsibility. Not everyone, though, does. And not everyone who chooses to forgo vaccination is doing so because they shun the common good. 

I accept, acknowledge, and appreciate that vaccination is a personal decision. It is, though, a personal decision with public and community ramifications. People get to make their own health care decisions, but it doesn’t mean that at times there aren’t consequences to those decisions. It also doesn’t mean that the community doesn’t have the right to insist that in order to partake in community programs individuals have to be vaccinated. 

Because I am aware that not everyone around my children is vaccinated and that vaccination is not 100% effective, I choose to have my children vaccinated in order to give them the best possible chance to avoid catching an infectious disease. We can’t avoid all possible infectious disease through vaccination; we must watch, sometimes helplessly, as our children fight infections. Where I can safeguard my children, I will.

*I have friends who do not vaccinate their children. I am not condemning them; I am stating my position. I respect individuals’ rights to make different healthcare decisions. 

I do not, though, believe people who are disseminating inaccurate information have a right to do so without being countered. 


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